STOP — Contraindicated
🔴 STOP — Contraindicated. Do not take St. Johns Wort with Tramadol. This combination can cause serious harm or death.
Evidence level: STRONG
Tramadol already carries serotonin syndrome risk alone. Adding St. John's Wort is significantly more dangerous, with added seizure risk.
Tramadol has serotonergic activity. St. John's Wort adds further serotonin load → seizure risk + Serotonin Syndrome.
Do NOT take St. Johns Wort and Tramadol together under any circumstances. If you are currently taking both, contact your doctor or pharmacist immediately — do not stop either medication abruptly without medical guidance.
Take Tramadol exactly as prescribed. St. Johns Wort can be taken with a meal at a different time. Sedating botanicals (valerian, kava, passionflower) can amplify opioid sedation and respiratory depression. Stimulating adaptogens (rhodiola, ginseng) may be safer choices during opioid therapy.
Risk increases with higher doses of either substance, older age, liver or kidney impairment, and concurrent use of other serotonergic or CNS-depressant substances.
Agitation, confusion, rapid heartbeat, high blood pressure, dilated pupils, muscle twitching, diarrhea, high body temperature, seizures. Seek emergency care immediately.
Show this page to your doctor. Ask: "I want to take St. Johns Wort but I'm on Tramadol. What safe alternatives do I have?"
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
Tramadol already carries serotonin syndrome risk alone. Adding St. John's Wort is significantly more dangerous, with added seizure risk.
Take Tramadol exactly as prescribed. St. Johns Wort can be taken with a meal at a different time. Sedating botanicals (valerian, kava, passionflower) can amplify opioid sedation and respiratory depression. Stimulating adaptogens (rhodiola, ginseng) may be safer choices during opioid therapy.
Agitation, confusion, rapid heartbeat, high blood pressure, dilated pupils, muscle twitching, diarrhea, high body temperature, seizures. Seek emergency care immediately.
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
Show this page to your doctor. Ask: "I want to take St. Johns Wort but I'm on Tramadol. What safe alternatives do I have?"
Or browse the full interaction database (121,000+ pairs).